Published: Wednesday 12th November 2014 by The News Editor
NHS England’s oversight of out-of-hours GP services is “inadequate”, contributing to wide variations in quality and cost, a public spending watchdog has said.
The Commons Public Accounts Committee found that not enough was done to prevent conflicts of interest between the bodies commissioning out-of-hours services and the GPs providing the coverage.
The MPs also raised concerns about planning for the number of family doctors that would be required in the future, warning that NHS England did not have a model for how many GPs will be needed in six years’ time.
The report found the urgent care system was “complex and fragmented” and called for the NHS to ensure people had a greater awareness of the options available to them in order to ease the burden on A&E departments.
The committee’s report said: “NHS England’s oversight of the value for money of out-of-hours GP services has been inadequate.”
The service was viewed as a low priority and NHS England “did not collect enough information to provide it with adequate assurance” that taxpayers’ money was being spent properly.
The report identified significant variations in cost and quality of services across England.
The cost per case across the country ranged from £29 to more than £134 in 2013/14 and the proportion of people in each area who rated their experience as “very good” or “fairly good” ranged from 49% to 86% in July this year.
The report highlighted areas where there were links between the clinical commissioning groups (CCGs) and the organisations providing out of hours care.
“Clinical commissioning groups are not presently managing conflicts of interest when commissioning out-of-hours GP services,” the report said.
“They should be able to demonstrate that they are.”
The report added that some CCGs had “awarded out-of-hours contracts without a competitive procurement process which, when coupled with the potential for conflicts of interest, increases the risk to propriety and value for money”.
The report said the design of the system, introduced as part of the coalition Government’s NHS shake-up, “brings an inherent risk of conflicts of interest”.
“The issue should have been properly addressed before clinical commissioning groups were introduced,” the MPs said.
“For example, in Barnet, Enfield and Haringey a large number of GPs who work for the clinical commissioning groups also have shareholdings in the organisation that provides out-of-hours care.”
The committee’s Labour chairwoman Margaret Hodge said: ” People turn to out-of-hours GP services when they are worried about their own health or that of family or friends, and want urgent advice or treatment.
“However, the urgent and emergency care system is complex and people struggle to know which is the right service to use.
“Too many people are unaware of the different urgent care options – such as out-of-hours GP services, walk-in centres, urgent care centres and A&E departments – and of how to contact them.
“This means people may not receive care in the most appropriate setting. As a result of the confusion, too many go to A&E when they do not need to.”
She added: “NHS England also needs to address the financial incentives which get in the way of different urgent care services working effectively together. Existing contracts provide incentives for A&E to hang onto patients and do not provide incentives to encourage out-of-hours services to take on more patients.
“Looking to the future, the Department of Health and NHS England must develop information to be able to know whether there will be enough GPs to cope with the growing workload.
“NHS England cannot afford to wait for budgets to be set to predict how many GPs will be needed given the time it takes to train new GPs.”
The report said: “NHS England does not currently have a model to predict how many GPs will be needed in 2020 and does not intend to develop one until it has more certainty about the NHS budget to the end of the decade.”
Dr Maureen Baker, chairwoman of the Royal College of General Practitioners, defended the out-of-hours service.
She said: “Out-of-hours GP services in the main are very good, so it is frustrating that the hard work and commitment of many GPs across the country is once again coming into question.
“A report by the Care Quality Commission last month concluded that the majority of out-of-hours services were ‘safe, effective, caring, responsive and well-led’ and chief inspector of general practice Professor Steve Field noted that he was pleased to see many examples of good and outstanding practice.
“There is always room for improvement. Our patients deserve the best quality care wherever in the country they live, in and out of hours, so any variation in the care that our patients receive does need attention.
“But at a time when GPs are facing increasing workloads, with a chronic lack of resources, it is clear that GPs are doing an excellent job.”
She said we “desperately need at least 8,000 more GPs” in England and backed the call by the committee for NHS England to act now.
It was “difficult to see how conflicts of interest can be avoided” if local GPs are to provide out-of-hours care to their communities.
” What is important is that good governance and transparency around conflicts of interests exists, and that our patients are aware of them,” she said.
A spokesman for NHS England said: ” GPs are working incredibly hard, and for less than the cost of a cinema ticket they provide everyone in this country with year-round access to out-of-hours GP and 111 services. What’s more the real terms cost of doing so has been coming down year by year.
“This report, which looks at the position a year ago, is however right to underline the benefits of much greater integration of GP, ambulance, and hospital emergency and urgent care services as proposed in the NHS five-year forward view.”
Published: Wednesday 12th November 2014 by The News Editor